Therapy of keloid and hypertrophic scars: a review

Efficacy and Safety of Corticosteroid in Combination with 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis

BACKGROUND

Addressing hypertrophic scars and keloids poses a significant challenge in the realm of preventive and curative medicine. Combination corticosteroid with 5-fluorouracil (5-FU) is presumed to enhance the treatment of hypertrophic scars and keloids, although supportive evidence is lacking. This study is aimed at comparing the efficacy and safety profile of a combined corticosteroid and 5-FU regimen in treating hypertrophic scars and keloids.

METHODS

A comprehensive search was conducted for pertinent studies across various databases, including Web of Science, PubMed, Google Scholar, Cochrane Library, and Medline. The calculation of weighted mean difference (WMD), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CIs) was executed. Additionally, the Cochrane Collaboration's Risk of Bias Tool was utilized to evaluate potential bias risks.

RESULTS

A total of 15 studies were involved. The effectiveness based on patient self-assessment and the effectiveness based on observer assessment were significantly higher in the corticosteroid+5-FU group compared to those treated with control. A meta-analysis of scar height showed that the corticosteroid+5-FU group performed better than the control group (WMD = -0.38, 95% CI -0.58 to -0.18). There was no significant difference between the corticosteroid+5-FU group and the control group in improving scar vascularity, pliability and pigmentation. The result revealed that the corticosteroid+5-FU group of patients had less adverse effect of hypopigmentation, skin atrophy and telangiectasia than the control group.

CONCLUSION

The combined use of corticosteroids and 5-FU appears to be a more effective strategy for the treatment and prevention of hypertrophic scars and keloids, as evidenced by greater improvements in scar height and overall effectiveness, coupled with a reduced incidence of side effects.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

RNA-seq-based analysis of the hypertrophic scarring with and without pressure therapy in a Bama minipig model

Pressure therapy has been proved to be an effective treatment for hypertrophic scars in a clinical setting. However, evidence-based data are controversial and the precise mechanism of action of this technique remains unknown. The aim of this study was to investigate the potential molecular mechanisms of pressure therapy for hypertrophic scars. We established a Bama minipig (Sus scrofa) model of hypertrophic scarring in which the scars were treated with pressure to explore the mechanism of action of the treatment. There were 568 differentially expressed genes (289 upregulated, 279 downregulated) after pressure therapy at 90 days post-injury, whereas only 365 genes were differentially expressed (250 upregulated, 115 downregulated) at 120 days post-injury. These genes were associated with metabolic pathways, ECM-receptor interaction, the PI3K-Akt and MAPK signaling pathways, focal adhesion and cytokine-cytokine receptor interaction. In addition, the qRT-PCR results indicated that the trend of gene expression following pressure therapy was mostly consistent across the two methods. In conclusion, our systematic analysis of the transcriptome has provided a better understanding of the molecular mechanisms involved in pressure therapy and offers an important basis for further studies of the complex signaling pathways regulated by the treatment.

[The role of CO2-laser in scarring management]

AIM

To assess the role of CO2-laser in treatment of various scars and to determine the indications for its application.

PATIENTS AND METHODS

It has been carried out a prospective analysis of treatment of 218 patients with scars of different duration, locations and anatomic areas with the use of CO2-laser for the period 2011-2017. POSAS scale and sonography were used for analysis.

RESULTS

1. Laser therapy is not effective for scarring-related functional defects (contractures, ectropion, microstomia), when surgery is indicated. 2. The outcomes of treatment (both surgical and laser) depend on the time of existence of the scars rather their cause and anatomical region. 3. Laser therapy is not effective enough for formed scars existing over 12 months. 4. Laser therapy is effective for immature scars, especially indicated for cicatricial deformation when the aesthetics cannot be repaired with traditional surgery.

CONCLUSION

Application of CO2-laser in scars treatment with regard to its real efficiency determines the effectiveness of therapy.

Molecular signalings in keloid disease and current therapeutic approaches from natural based compounds

CONTEXT

Keloid is an excessive dermal scar occurring in response to skin injuries. Several therapeutic strategies have been proposed to ease the aggressiveness of keloid scarring. Even though the principle mechanism underlying the disease propagation still remains unidentified, several signaling pathways were highly focused as plausible pathways involving keloid formation, including transforming growth factor-beta 1 (TGF-β1), mitogen-activated protein kinase (MAPK), insulin-like growth factor-I (IGF-I), and integrin pathways. Natural compounds containing multiple bioeffective properties such as quercetin, asiaticoside, Astragalus membranaceus Bunge. (Leguminosae), and Salvia miltiorrhiza Bunge. (Lamiaceae) extracts, curcuminoids, oxymatrine, madecassoside, and Aneilema keisak Hassk. (Commelinaceae) are claimed as candidates for therapeutic treatment against keloid disorder.

OBJECTIVE

This review investigates current mechanisms regarding keloid formation and provides scientific evidence supporting the therapeutic potential of natural compounds.

METHODS

This review obtained and analyzed a number of literature data items from various databases including Pubmed, ScienceDirect, and Elton B. Stephens Company (EBSCO).

RESULT

Several phytochemical compounds are able to suppress keloid scar development through manipulating various components in the complex signaling cascades.

CONCLUSION

The present review may be helpful to future studies that further examine the molecular mechanism of keloid etiology as well as investigate the anti-keloid property in natural compounds.